Assessing the irradiance levels of phototherapy devices in Jos, north central, Nigeria

Background: Neonatal jaundice (NNJ) remains a major cause of neonatal morbidity and mortality in Nigeria with significant contribution to the global figures. Effective phototherapy can reduce the complications associated with NNJ. The effectiveness of a phototherapy device (PD) depends mainly on the emitted irradiance of the device. We, therefore, assessed the irradiance of the PDs in Jos, North Central Nigeria in order to determine the effectiveness of the devices and to highlight the need for routine assessment of irradiance levels of PDs in low-middle income settings.Methods: This was a cross- sectional study involving 14 hospitals with a total of 38 functional PDs comprising of 25 (65.8%) locally fabricated, eight (21.0%) light- emitting diode (LED) and five (13.2%) conventional patented devices. The irradiance was measured using the BiliBlanket® light meter II.Results: The irradiance of the PDs ranged from 2 to 102μW/cm2/nm with a median value of 10.6 (IQR 6-18μW/cm2/nm).   Sixteen devices (42.1%) had a suboptimal irradiance (<10μW/cm2/nm); while only five (13.2%) provided irradiance at the intensive level (≥30μW/cm2/nm). The mean distance between the babies and phototherapy lights was 35.1±12.7cm (range 15-70cm).Conclusions: A significant proportion of the PDs in Jos delivered suboptimal irradiance which could reduce the effectiveness of the phototherapy. The irradiance of PDs needs to be assessed regularly and measures should be instituted to improve the irradiance to the optimum level in order to reduce the burden of kernicterus

Knowledge of electronic medical records system among frontline health care workers in Jos University teaching hospital, Plateau State Nigeria

Background: Electronic Medical Records system (EMRs) in any healthcare system has the potential to transform healthcare in terms of saving costs, reducing medical errors, improving service quality, increasing patients’ safety, decision-making, saving time, data confidentiality, and sharing medical. Evidence on the current state of EMR system in Nigeria health system particularly its knowledge among health professionals is limited. Hence, this study was conducted to assess the level of knowledge EMRs among frontline health care workers in a tertiary health institution in Jos, Plateau State.Methods: This was a cross-sectional study conducted between April and August 2019 among 228 frontline health care workers in Jos University Teaching Hospital using quantitative method of data collection. SPSS version 20 was used for data analysis and a p-value of ≤ 0.05 considered statistically significant.Results: The mean age of the respondents in this study was 35 ± 8 years with 93 (40.8%) being 36 years and above. The overall level of knowledge of EMRs was adjudged to be good among 163 (71.5%) of the participants. Category (pharmacists) of the respondents was found to influence good knowledge of EMRs (OR = 1.37; 95% CI = 1.007 – 1.865; p = 0.045).Conclusions: This study has demonstrated a relatively high level of good knowledge of EMRs with variation existing along the categories of health care workers bringing to light the existence of a good knowledge base in the light of future EMRs implementation

Loss of capillary pericytes and the blood–brain barrier in white matter in poststroke and vascular dementias and Alzheimer’s disease

White matter (WM) disease is associated with disruption of the gliovascular unit, which involves breach of the blood‐brain barrier (BBB). We quantified pericytes as components of the gliovascular unit and assessed their status in vascular and other common dementias. Immunohistochemical and immunofluorescent methods were developed to assess the distribution and quantification of pericytes connected to the frontal lobe WM capillaries. Pericytes with a nucleus were identified by collagen 4 (COL4) and platelet derived growth factor receptor‐β (PDGFR‐β) antibodies with further verification using PDGFR‐β specific ELISA. We evaluated a total of 124 post‐mortem brains from subjects with post‐stroke dementia (PSD), vascular dementia (VaD), Alzheimer’s disease (AD), AD‐VaD (Mixed), and post‐stroke non‐demented (PSND) stroke survivors as well as normal ageing controls. COL4 and PDGFR‐β reactive pericytes adopted the characteristic “crescent” or nodule‐like shapes around capillary walls. We estimated densities of pericyte somata to be 225 ±38 and 200 ±13 (SEM) per COL4 mm2 area or 2.0 ±0.1 and 1.7 ±0.1 per mm capillary length in young and older ageing controls. Remarkably, WM pericytes were reduced by ~35‐45 percent in the frontal lobe of PSD, VaD, Mixed and AD subjects compared to PSND and controls subjects (P&lt;0.001). We also found pericyte numbers were correlated with PDGFR‐β reactivity in the WM. Our results first demonstrate a reliable method to quantify COL4‐positive pericytes and then indicate that deep WM pericytes are decreased across different dementias including PSD, VaD, Mixed and AD. Our findings suggest that down regulation of pericytes is associated with the disruption of the BBB in the deep WM in several ageing‐related dementias

Cord Care Practices: A Perspective of Contemporary African Setting

BackgroundCord care is the series of steps applied in handling of the umbilical cord after delivery of the new born. Globally, an estimated 4 million deaths occur annually within the first 4 weeks of life and 1.5 million of these deaths are attributable to infections. In Nigeria, studies have reported umbilical cord infections accounting for between 10 and 19% of neonatal admissions and resultant estimated 30–49% neonatal deaths. Hence, this study was conducted to assess the knowledge and practice of cord care within a contemporary setting.MethodologyThis was a cross-sectional study conducted among 324 mothers of children less than 59 months using a multistage sampling technique and SSPS version 20 was used for data analysis. Crude and adjusted odds ratios as well as 95% confidence interval were used in this study with a P-value of ≤0.05 considered statistically significant.ResultsThe mean age of the mothers in the study was 27.5 ± 6 years with majority of them having good overall knowledge and practice of cord care. Factors such residence in rural community (AOR = 0.26; 95% CI = 0.0915–0.7230) and heath facility delivery (AOR = 7.0; 95% CI = 4.7877–9.3948) were predictors of cord care practices.ConclusionThis study has brought to light the level of cord care practices with health facility delivery, place of residence, and knowledge of cord care as its determinants

Level of utilization and provider-related barriers to the use of hydroxyurea in the treatment of sickle cell disease patients in Jos, North-Central Nigeria

Background: Hydroxyurea is underutilized by sickle cell health-care providers in Nigeria despite available evidence of its effectiveness in reducing the manifestations and complications of sickle cell disease (SCD). Objectives: To assess the level of utilization and provider-related barriers to the use of hydroxyurea in SCD therapy in Jos, Nigeria. Methods: A cross-sectional study conducted among 132 medical doctors providing care for SCD patients. Data on so- cio-demographics, utilization and barriers to hydroxyurea use were obtained. The barriers were fed cumulatively into the logistic regression model as predictors of utilization. Results: Of the 132 care providers, 88 (67%) had been in medical practice for ≥6years. The level of utilization of hy- droxyurea was 24.2%. The significant barriers that predicted the non-utilization of hydroxyurea included lack of expertise (OR=5.1; 95% CI=2.65–9.05), lack of clinical guidelines (OR=3.84; 95% CI=2.37-14.33), fear of side-effects (OR=0.50; 95% CI=0.22–0.68) and doubt about its effectiveness (OR=0.30; 95% CI=0.20–0.90). Conclusion: The level of utilization of hydroxyurea in the treatment of SCD among the care providers is sub-optimal with the lack of expertise in its use identified as the most prominent barrier. There is an urgent need for the training of sickle cell care-providers and the development of clinical guidelines on hydroxyurea use

Avascular necrosis in children with sickle cell disease: prevalence and pattern of presentation in Jos, Nigeria

Background: Avascular necrosis (AVN) is a common orthopaedic complication of sickle cell disease (SCD). Despite the previously reported childhood-onset of AVN, its actual prevalence among children with SCD in Nigeria is not known. Hence, we determined the prevalence and pattern of presentation of AVN in a homogenous paediatric population with SCD in Jos.Methods: A cross-sectional study of children with SCD aged 5-17 years using a review of data from the SCD-registry of the Paediatric Haematology-oncology unit of Jos University Teaching Hospital from January 2016 to January 2021.Results: Of the 589 children, 523(88.8%) had haemoglobin SS genotype while 59 (10%) and seven (1.2%) had haemoglobin SS+F and SC genotypes respectively. Thirty- eight children (20 males (52.6%) and 18 (47.4%) females) were diagnosed with AVN of the femoral head giving an overall prevalence of 6.5%. Five of the 38 children had a concomitant AVN of the shoulder giving a prevalence of 0.8%. Their ages at the time of diagnosis of AVN ranged from 7-17 years (mean: 13.6±3.2 years). The prevalence of AVN increased from 1.9% to17.3% among age groups 5-9 years and 15-17 years respectively. Majority of the children (75.8%) presented at the late stages of the disease.Conclusion: Avascular necrosis of the hip is common among children with SCD and it could occur early in childhood. Most of the children presented at the late stages of the disease. Therefore, we recommend early and routine screening of children with SCD for AVN in Nigeria

Serum zinc status in sickle cell anaemia children at the Jos University Teaching Hospital, Jos, Nigeria

Background: Several clinical manifestations of sickle cell anaemia (SCA) have been associated with zinc deficiency. Determining the zinc status of children with SCA in Nigeria, a country that accounts for the highest burden of the disease worldwide, will provide a template that could assist in critically appraising the need or otherwise for zinc supplementation or fortification programmes in these children.Methods: This was a cross-sectional comparative study conducted at the Jos University Teaching Hospital, Jos, Nigeria among 700 children (350 SCA patients and 350 age and sex matched hemoglobin AA controls). Serum zinc was analysed using the atomic absorption spectrophotometry.Results: The median serum zinc concentration of children with SCA was 6(3-7) μmol/l and it was significantly lower than that of the controls 8(4-9) μmol/l, p = 0.04. The prevalence of zinc deficiency in this study was 67% in children with SCA compared with 34% in the control group, (p&lt;0.0001). Theproportion of zinc deficient patients was more among children from lower socio economic class (68.5%, 35.5%) than in the upper socio economic class (38.5%, 16.3%) in both cases and controls groups respectively.Conclusion: There is a high prevalence of zinc deficiency in the study population especially among those with sickle cell anaemia. Zinc  supplementation or fortification should be considered as part of  intervention strategies to improve the zinc status of these children particularly those with sickle cell anaemia.Key words: Serum zinc, Sickle cell anaemia, children, Jos, Nigeri